Continence of anal canal is maintained by two factors:
- Normal rectal and colonic pressure and activity.
- Normal pelvic floor function.
- Urge incontinence—here rectal and colonic pressure and activity is increased but normal pelvic floor.
- True incontinence—here rectal and colonic pressure and activity is normal but defective pelvic floor function.
- Full incontinence—here rectal and colonic pressure and activity is reduced and also defective pelvic floor function.
- Temporary—treated by reassurance. Often seen after Lord’s dilatation.
- Permanent—needs definitive therapy.
Causes of anal incontinence
- Denervation—spinal injury, spina bifida.
- Damage—childbirth, wounds, surgeries
- Descent—rectal prolapse, perineal descent
- Debility—old age, diseases
- Destruction—RT, malignancy
- Dementia—senility, psychosis
- Deficiency—congenital anomalies
- Irritable bowel syndrome, severe diarrhoea.
- Prolapsed piles, rectal prolapse.
- Old age, malnutrition, debilitating illness.
- Congenital anomalies.
- Trauma, surgeries, injury during childbirth in females.
- Spina bifida, spinal tumours, spinal injuries and surgeries.
- Malignancy, postirradiation.
- Psychological causes.
Evaluation of the patients:-
The medicines that can be thought of use are:-